Urinary Calculus. Urolithiasis
WHAT ARE URINARY STONE?
Urinary calculus is a stone like body composed of urinary salts bound together by a colloid matrix of organic materials that form anywhere in the urinary tract and may cause pain, bleeding, obstruction of the flow of urine, or an infection. Depending on where a stone forms, it may be called a kidney stone, ureteral stone, or bladder stone. The process of stone formation is called urolithiasis, renal lithiasis, or nephrolithiasis.
What are stones composed of?
More often the stones are composed of calcium and the remainder are composed of various substances, including uric acid, magnesium ammonium phosphate, cystine, and struvite. The different compositions give us an idea of its complexity since not all these kind of stones can be resolved undergoing the same treatment.
What are the urinary stones symptoms?
The most common is the feared nephritic colic characterized by an excruciating intermittent pain, usually in the flank (the area between the ribs and hip), that spreads across the abdomen, often to the genital area and inner thigh causing nausea and vomiting, restlessness, sweating. A person may have an urge to urinate frequently and/or hematuria. They may cause urinary tract infections. They are not always painful and sometimes they are tracked down just by chance in Radiography or ultrasounds tests.
Is a nephritic colic always caused by stones?
No necessarily, however it´s the most frequent reason. Nephritic colic occurs when a stone is deposited in the renal collecting system (even temporarily), increasing intraluminal pressure and causing intense pain. The obstruction can be caused by blood clots, urethral stenosis (narrowing of the urethra), tumors, etc
Should be always nephritic colic be treated by the urologist?
Yes, absolutely. During the stage of acute pain any doctor can correctly treat it. But later that patient should be referred to the urologist, the medical specialist that will be able to find out the causes and to purpose the right solutions to prevent that it happens again.
What leads to develop urinary stones?
A number of different medical conditions can lead to develop kidney stones. It may be linked to conditions associated with an increased risk of kidney stones (hyperparathyroidism, hyperucemia), or the cause my by located, intrinsically, within the urine composition (hypercalcuria, hyperoxaluria, citrate deficit) or due to an alteration in function within the urinary tubes (congenital malformations, urinary infections, blockages). A thorough urologic check up will help to discover the root causes.
How is the urinary stones medical treatment?
There is no standard treatment: the size, location, degree of symptoms, and presence or absence of urinary infection and obstruction influence the treatment
What treatments are available to urologists?
· Open surgery
· Extracorporeal shock wave lithotripsy (ESWL)
· PCN (percutaneous nephrolithotomy-lithotripsy)
· Endourology (endoscopic removal or manipulation)
Treatments are not considered mutually exclusive, sometimes it´s required combine more than one technique to be able to remove the stone.
Do prescription drugs dissolve kidney stones?
Medical treatment is more successful in prevention of stones than in dissolving them after they have formed. The majority of kidney stones cannot be dissolved because they contain calcium; however, uric acid and cystine can be dissolved. A large number of stones are small enough to pass spontaneously (Drinking a large quantity of water helps) but if the stones remain inside, the vast majority in fact, will have to be treated using any of the procedures described above.
How can one prevent the formation of kidney stones?
Minimizing the risks by boosting fluid intake, specially water, in order to prolong the average interval of recurrence and to excrete a more diluted urine will prevent the precipitation of substances that may lead to calculi formation
Specific dietary recommendations may only be made once the urologist has studied each individual case since there are many different types of kidney stones each of which will require a different set of measures.